Uterosacral ligament vaginal vault suspension (USVVS) is commonly performed for pelvic organ prolapse and offers a minimally invasive alternative to the transabdominal route. Nonetheless, as with any major surgical procedure, there are complications specific to this approach. Complications common to many reconstructive procedures, including urinary tract infection, wound infection, venous thrombosis, and positioning-related neuropraxias, are discussed elsewhere. We focus on the most common complications specific to USVVS including hemorrhage, ureteral injury, bowel injury or obstruction, and peripheral nerve injury.